Provider Demographics
NPI:1730350281
Name:ADVANCED PSYCHIATRIC INTERVENTIONS
Entity type:Organization
Organization Name:ADVANCED PSYCHIATRIC INTERVENTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHYTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:FNP-C, PHD
Authorized Official - Phone:248-681-0623
Mailing Address - Street 1:950 N CASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2370
Mailing Address - Country:US
Mailing Address - Phone:248-681-0623
Mailing Address - Fax:248-681-0927
Practice Address - Street 1:950 N CASS LAKE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2370
Practice Address - Country:US
Practice Address - Phone:248-681-0623
Practice Address - Fax:248-681-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4368404Medicaid
MI5008670150OtherBCBS
MI1005206330Medicaid
MI5008770600OtherBCBS
MIE26216Medicare UPIN
MI1005206330Medicaid
MI4368404Medicaid